喉罩通气静脉-吸入复合麻醉在小儿腹股沟斜疝疝囊高位结扎术中的应用

Application of laryngeal mask ventilation in the operation of indirect inguinal hernia of children under combined intravenous and inhalation anesthesia

目的探讨喉罩通气静脉-吸入复合麻醉在小儿腹股沟斜疝疝囊高位结扎术中的应用价值。方法选择2017年6月至2018年6月于焦作市妇幼保健院行腹股沟斜疝疝囊高位结扎术的80例患儿为研究对象,根据麻醉措施分为观察组和对照组,每组40例。观察组患儿实施喉罩通气静脉-吸入复合麻醉,对照组患儿实施无插管氯胺酮静脉全身麻醉。记录2组患儿的手术时间、麻醉苏醒时间,观察2组患儿麻醉前(T1)、切皮时(T2)、切皮后即刻(T3)、切皮后3min时(T4)、手术结束时(T5)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2),记录2组患儿术中体动及术后恶心呕吐、精神症状等不良反应发生情况。结果T1时2组患儿HR、MAP比较差异无统计学意义(P>0.05),T1、T2、T3、T4和T5时2组患儿SpO2比较差异均无统计学意义(P>0.05)。T2、T3、T4和T5时,观察组患儿HR、MAP低于对照组(P<0.05);观察组患儿T1、T2、T3、T4和T5时HR、MAP及SpO2比较差异均无统计学意义(P>0.05)。对照组患儿T2、T3、T4和T5时HR、MAP高于T1时(P<0.05),对照组患儿T1、T2、T3、T4和T5时SpO2比较差异均无统计学意义(P>0.05)。2组患儿手术时间比较差异无统计学意义(P>0.05),观察组患儿麻醉苏醒时间短于对照组(P<0.05)。观察组患儿术中体动发生率及术后恶心呕吐、精神症状(烦躁、幻觉)发生率低于对照组(P<0.05)。结论 喉罩通气静脉-吸入复合麻醉用于小儿腹股沟斜疝疝囊高位结扎术中麻醉效果好,患儿苏醒快,且不良反应少。

Objective To investigate the application value of laryngeal mask ventilation in the operation of indirect inguinal hernia of children under combined intravenous and inhalation anesthesia. Methods A total of 80 children with indirect inguinal hernia who underwent high ligation of hernial sac from June 2017 to June 2018 in Jiaozuo Maternal and Child Health Hospital were selected as the research subjects.The children were divided into observation group and control group according to the anesthetic measures,40 cases in each group.The children in the observation group were given laryngeal mask ventilation and combined intravenous and inhalation anesthesia,while the children in the control group were given ketamine intravenous general anesthesia without intubation.The operation time and anesthesia recovery time of the children in the two groups were recorded.The heart rate (HR),mean arterial pressure (MAP),pulse oxygen saturation (SpO 2) of children in the two groups were measured at the time points of before anesthesia (T 1),during skin incision (T 2),immediately after skin incision (T 3),3 minutes after skin incision (T 4) and the end of operation (T 5).The occurrence of intraoperative restlessness and the adverse reactions such as nausea,vomiting and psychiatric symptoms were recorded. Results There was no significant difference in the HR and MAP between the two groups at T 1 ( P >0.05).There was no significant difference in the SpO 2 between the two groups at T 1,T 2,T 3,T 4 and T 5 ( P >0.05).The HR and MAP of children in the observation group were lower than those in the control group at T 2,T 3,T 4 and T 5 ( P <0.05).There was no significant difference in HR,MAP and SpO 2 at T 1,T 2,T 3,T 4 and T 5 in the observation group ( P >0.05).The HR and MAP at T 2,T 3,T 4 and T 5 were higher than those at T 1 in the control group ( P <0.05).There was no significant difference in the SpO 2 at T 1,T 2,T 3,T 4 and T 5 in the control group ( P >0.05).There was no significant difference in operation time between the two groups ( P >0.05).The recovery time of anesthesia in the observation group was shorter than that in the control group ( P <0.05).The incidences of intraoperative restlessness,nausea,vomiting and psychiatric symptoms (irritability-restlessness and hallucination) in the observation group were lower than those in the control group ( P <0.05). Conclusion Laryngeal mask ventilation and combined intravenous and inhalation anesthesia for high ligation of hernial sac in children with indirect inguinal hernia has the advantages of good anesthetic effect,quick recovery and less adverse reactions.